ABSTRACT

Chest trauma is common and is the second leading cause of death among patients; death can happen within the first hour of hospital arrival (second to central nervous system injury). This can be complicated by the presence of the casualty in a resource-limited environment where diagnostics available in day-to-day civilian practice may not be readily available. There will be a greater demand on clinical skills alongside portable imaging modalities. In a civilian environment with ample resources, up to 90% of chest injuries may be successfully managed non-operatively with chest drain, chest physiotherapy, and analgesia (as appropriate).

Patients requiring surgery typically have injuries ranging from minimal to catastrophic. For penetrating trauma, the conventional indications for exploration include

An isolated thoracic injury with profound hypotension;

Initial chest tube output greater than 1500 mL−1;

A persistent chest tube output of 200–300 mL hour−1 over 3-4 hours;

Cardiac tamponade or any suspicion of tamponade, including indeterminate ultrasound examination; and

Massive air leak with impaired oxygenation and/or ventilation.

Indications for surgical exploration after blunt trauma are similar; however, most blunt injuries result in very unsatisfying surgical experiences. Most of these can be managed with chest drains alone.